Scandiatransplant priority for urgency in lung transplantation – A 5 year multicentre experience

Abstract

When allocating lungs for lung transplantation (LuTx), usually priority is given according to defined criteria of urgency (USA, Eurotransplant, France), possibly impairing overall survival after LuTx. In 2009, the Scandiatransplant cooperation introduced the Urgent Call (UC) system, allowing priority for a fixed number of 3 patients per year for each centre, without defined criteria of urgency. This study aims to assess the selection and outcome of UC patients. Methods: We have included clinical data at the time of listing of all 57 UC patients from 2009-2014 in the 5 LuTx centres in Scandinavia, and compared outcomes to patients transplanted from normal waiting list between 2009-2014 (n=760). Results: Median waiting time was 6.5 days from urgent listing to transplantation compared to 90 days from normal waiting list. Three died on UC waiting list after 3, 16 and 39 days respectively. No difference in survival after transplantation among the UC patients was observed when stratifying for diagnosis or age, but UC patients on ECMO or mechanical ventilation had a significantly lower survival than other UC patients (p=0.015). Compared to the total Scandiatransplant data in the same period, the UC patients had a similar survival after LuTx (p=0.227). Conclusion: The Urgent Call system does allow critically ill patients to be transplanted with a short waiting time, low waiting list mortality and good outcomes regardless of age or diagnosis. UC Patients transplanted from ECMO or mechanical ventilation have impaired short term survival after transplantation, but long term survival seems to be similar to UC patients transplanted from non-invasive ventilation or no respiratory support.